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O Shd
notes
| Term | Definition |
|---|---|
| 1st visit | sidelying ER (or standing w/same motion), prone ER, empty or full can |
| add on 2nd visit | horizontal abd w/scap retract & maybe push-up + |
| add on 3rd visit | rows |
| stretch | pec stretch in corner |
| synovial jts | GH, AC, SC |
| GH (glenohumeral jt) | head of humerus in glenoid |
| glenohumeral lig | limits ant displacement & ER (superior, middle, inferior) |
| coracohumeral lig | limits flex & ext |
| SC (sternoclavicular) jt ligs | ant sternoclavicular, interclavicular (not articular fibrocartilage disc), SC jt glides during elevation, depression, protraction & retraction of scap |
| AC (acromioclavicular) jt ligs | acromioclavicular, coracoclavicular (conoid & trapezoid), very small gliding mvmts during scap mvmts |
| bursa of shd | can be called subacromial or subdeltoid bursa |
| jt capsule | large, loose, inferiorly taut/superiorly folds upon self, very redundant. lined w/synovial tissue. inc the tendon of long head of biceps. tendons of cuff & GH lig support the jt capsule & provide stability |
| glenoid labrum | deepens glenoid, fibrocartilage ring. if torn can be traumatic or degenerative. it's an avascular area, if torn prob needs sx |
| capsular pattern | limited ER, ABD, IR. arthrokinematics, end feel-springy (capsular is normal), convex moving on concave |
| rx capsular pattern | passive stretching & jt mob |
| mm of shd | infraspinatus, teres minor, subscapularis, deltoid, coracobrachialis, pectoralis, biceps, triceps, pec minor |
| pec major | O-med 1/3 of clavicle, sternum, costal cartilage of 1st 6 ribs. I-lat lip bicipital grv of humerus. A-shd add, IR, hor ADD, shd flex 60, shd ext 60. N-lat & med pec |
| pec minor | O-ant surface, 3-5th ribs. I-coracoid process of scap. A-scap depress, protract, down rot & tilt. N-med pec |
| ant delt | O-lat 1/3 of clavicle. I-delt tuberosity. A-shd abd, flex, med rot, hor add. N-axillary |
| middle delt | O-acromion process. I-deltoid tuberosity. A-shd abd. N-axillary |
| post delt | O-spine of scap. I-deltoid tuberosity. A-shd abd, ext, hyperext, lat rot, hor abd. N-axillary |
| teres minor | O-axillary border of scap. I-greater tubercle of humerus. A-shd lat rot, hor abd. N-axillary |
| infraspinatus | O-infraspinous fossa of scap. I-greater tubercle of humerus. A-shd lat rot, hor abd. N-suprascapular |
| subscapularis | O-subscap fossa of scap. I-lesser tubercle of humerus. A-shd IR. N-subscapular |
| upper trap | O-occipital bone, nuchal lig. I-outer 1/3 of clavicle, acromion process. A-Scap elevation & upward rot. N-spinal accessory |
| middle trap | O-spinous processes of C7 thru T3. I-scap spine. A-scap retraction. N-spinal accessory |
| lower trap | O-spinous processes of middle & lower throacic vertebrae. I-base of scap spine. A-scap depression & upwd rot. N-spinal accessory |
| rhomboids | O-spinous processes of C7-T5. I-vertebral border of scap btw spine & inf angle. A-scap retract, elevation, down rot. N-dorsal scap |
| serratus ant | O-lat surface of upper 8 ribs. I-vertebral border of scap, ant surface. A-scap protract & up rot. N-long thoracic |
| coracobrachialis | O-coracoid process of scapula. I-med surface of humerus near midpoint. A-stabilizes shd jt. N-musculocutaneous |
| biceps brachii | O-long head:supraglenoid tubercle of scap. short head: coracoid process of scap. I-radial tuberosity of radius. A-elbow flex, forearm sup. N-musculocutaneous |
| triceps | O:long head:infraglenoid tubercle of scap. Lat head: inf to greater tubercle on post humerus. med head:post surface of humerus. I-olecranon process of ulna. A-elbow ext. N-radial |
| mm of scapula | rhomboids, upper trap, middle trap, lower trap, serratus |
| ER | infraspinatus & teres minor |
| IR | subscapularis |
| shd observation | posture, symmetry, PROM/AROM/end feel, crepitance, tender areas, painful arc |
| coracoacromial arch | formed by: acromion, croacoacromial lig. houses:gr tubercle, rot cuff tendons, biceps tendon, subacromial bursa |
| impingement pn | when arm is overhead & then no pn when arm is down |
| downward rotation | force couple-pec minor, levator, rhomboids |
| upward rotation | force couple-upper traps, lower traps & serratus |
| scapulohumor rhythm | after 30-45 degrees of elevation there is 2:1 ratio. 2 degree GH motion: 1 degree scapular motion |
| role of posture | fwd tilt of scap, over stretched, wk rhomboids, serratus & trap wkness, tight pec minor/maj, levator, compression of subacromial space, faulty mechanics of shd elevation |
| bicipital tendinitis test | pn in ant inner shd w/resisted sup |
| drop arm test | pt unable to lower arm from 90 ABD, complete tear of supraspinatus |
| apprehension test | slowly abd & ext rot-ant glenohumeral dislocation |
| adsons test | TOS |
| impingement test | flex, IR, add humerus so that cuff impinges under acromion-pn indicates impingement |
| Apley's scratch test | opp shd, behind back, behind head |
| Speeds test | resist-GH flex w/elbow ext & palpate bicipital groove for bicipital tendonitis |
| traumatic shd dislocation | forceful abd & rot of the humerus. subscapularis tendon overstretches or tears along w/ant jt capsule & glenoid labrum. often unidirectional & more likely to require sx |
| non-traumatic shd dislocation | laxity of jt capsule w/o trauma. usually bilateral & multidirectional. may respond to rehab |
| PT management-non-surgical ant dislocation acute phase | usually have to follow MD protocol-RICE (may be immobilized in sling for 4 wks), PROM except ER w/ABD, AAROM ER amt frequently ordered by MD, Codmans/mm setting |
| PT management-non-surgical ant dislocation sub acute phase | AROM to wrist & elbow, physical agents for pn/edema, when ordered progress to AAROM, AROM, isometrics & resistive ex for cuff strengthening, cross friction massage, stretching, strengthening but cont to avoid ABD/ER |
| PT management for general shd instability | stretching generally not focus of rx, esp into ER, gen shd strengthening indicated esp RC & scapular mm, correction of poor posture to take stress of soft tissues, may need to modify activity to prevent overuse |
| Bankart repair | labrum & ant capsule reattached to glenoid |
| capsulorrhaphy (capsular shift) | loose capsule pinned or sutured (ETAC-electrothermally assisted capsulorrhaphy) |
| repair of a SLAP (sup labrum extending ant to post)lesion | reattach torn structures (usually labrum & biceps) |
| ant dislocation-post op rehab | wk 1-2-ROM & isometrics/ wk 3-4 begin resisted ex/ some protocols contraindicate ER & ABD for 1st 4 wks post op/ return to activity in 6-9 mos |
| adhesive capsulitis | frozen shd |
| primary adhesive capsulitis | unknown etiology. unknown stimulus produced. profound histological changes in the capsule resulting in fibrosis |
| secondary adhesive capsulitis | minor trauma or episode of inflammation that leads to disuse, tissue shortening & adhesions. onset is gradual & initially pn is the primary complaint, may be related to diabetes, immobilization |
| adhesive capsulitis S&S | pn in lat shd that initially is severe but eventually subsides to dull ache & stiffness, severe loss of motion in capsular pattern. motion is often restricted w/in 2-3 wks. night pn, cant sleep on involved side, empty end feel |
| adhesive capsulitis PT management acute/subacute | pn management AROM/PROM |
| adhesive capsulitis PT management chronic | jt mob, aggressive stretching, strengthening, some require manipulation under anesthesia, many spontaneously resolve but may take 2 yrs |
| most common cause of shd pn | biceps tendonitis |
| biceps tendonitis S&S | tenderness, pn w/stress to tendon (ie strong isometric contraction, sharp twinges on certain mvmt common, esp ext rot, abd) AROM-painful arc common. PROM-generally full |
| PT management of bicipital tendonitis acute & subacute | management w/physical agents and rest. ionto /phono used commonly |
| PT management of bicipital tendonitis chronic | heat, begin AAROM, AROM, resistive, friction massage, mobilization, stretching, must rx underlying cause (abt 80% posture & wkness of scap or RC mm) |
| bursitis | pretty rare, often occurs secondary to impingement or chronic tendonitis |
| bursitis S&S | lat arm pn, may refer to arm, dull ache under delt, hx of chronic tendonitis, AROM-noncapsular pattern, may have painful arc, painful elevation |
| bursitis rx | like tendonitis since causes the same...heat, begin AAROM, AROM, resistive, friction massage, mobilization, stretching, must rx underlying cause (abt 80% posture & wkness of scap or RC mm) |
| RTC impingement syndrome | result of repetitive microtrauma to tissues in coracoacromial space & decreased space between acromion & gr tubercle |
| RTC impingement syndrome causes | usually related to overhead activity such as tennis, military press, painting, swimming, ball throwing, associated w/scapular & RC wkness |
| RTC impingement syndrome tissues effected | long head of biceps, subacromial bursa, supraspinatus tendon |
| impingement | underlying cause is crowding of subacromial space, humeral head migrates superiorly during activity/delt overactive, SS underactive |
| impingement syndrome S&S | superior pn esp w/overhead activity, long hx of pn/microtrauma, painful arc (abd btw 70-120), positive impingement signs |
| PT management of impingement | rx like tendonitis, strengthening of cuff & post scap mm, stretching ok but avoid painful arc, correct functional probs, closed chain ex recommended as well as core strength |
| RCT (rotator cuff tear) causes | loss of subacromal space leads to: DJD, spurs, calcific tendonitis, chronic inflammation/scarring, wking of cuff tendon or mm due to age, microtearing or decreased vascularity, GH or scapulothroacic hypermob, or trauma |
| RCT (rotator cuff tear) trauma | microtrauma-esp deceleration phase of throwing-eccentric contraction, can be classified as complete or incomplete (rx conservatively-same as tendonitis) |
| RCT (rotator cuff tear) clinical signs | + drop arm test-full ABD to ADD-arm drops @ 90, loss of ADL function, wkness, + empty can test, PM pn, pn & wkness w/elevation, jt noise, atrophy |
| sx repair of RC | increase space between acromion & tendon, repair of tear w/sutures-reattachment of tendons if complete, arthroscopy most cases |
| most post op RC sx protocol | physician ordered |
| SC/AC jt sprain/dislocation type I | occurs w/trauma to jt but capsule & ligaments are intact |
| SC/AC jt sprain/dislocation type II (subluxation) | occurs when capsule tears but conoid & trapezoid ligaments are not. these connect the coracoid process & acromion |
| SC/AC jt sprain/dislocation type III (separation) | capsule, ligaments, overlying mm are torn & clavicle is displaced |
| TSA (total shd arthroplasty) | done in cases of severe OA, RA, there is option of hemiarthroplasty, outcome relatively poor w/ severely limited ROM & strength |
| PT management TSA | per MD protocol |
| complex regional pain syndrome (CRPS) | formerly RSDS (shd/hand syndrome)- a neuromuscular disorder of unknown etiology that frequently follows some type of trauma or other chronic prob. may also occur in LE, may last from months to years. |
| complex regional pain syndrome (CRPS) S&S | pn, edema, stiffness, discoloration |
| complex regional pain syndrome (CRPS) rx | pts need anti-inflammatories, steroids, sympathetic blocks, rx is difficult, often of limited effectiveness |
| complex regional pain syndrome (CRPS)components | sympathetic nervous system dysfunction, sensory dysfunction such as burning, motor dysfunction, trophic changes (sweating, loss of hair, shiny, temp change, thick nails) |
| complex regional pain syndrome (CRPS) type 1 | (reflex sympathetic dystrophy)- origin not related to nerve injury |
| complex regional pain syndrome (CRPS) type 2 | causalgia- develops after nerve injury |
| complex regional pain syndrome (CRPS) dx is 3/4 of ... | unduly prolonged or intense pn, stiffness, delayed functional recovery, trophic changes |
| PT management of CRPS | decrease pn, massage for edema, elevation/elastic compression, desensitization, manage limited mob depending on acuity, protect involved & uninvolved jts, contrast bath, ice, heat, compression, TENS, estim, phone, early PROM, AAROM, AROM as tolerated |
| common sources of referred pn in the shd region | cervical spine, referred pn from related tissues |
| nerve disorders in the shd girdle region | brachial plexus in the thoracic outlet, suprascapular nerve in the suprascapular notch, radial nerve in the axilla |
Created by:
jessigirrl4
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